感觉神经性耳聋的MRI研究

目的评价ＭＲＩ检查方法对探讨感觉神经性耳聋（ＳＮＨＬ）各种病因的价值。方法用ＳＥ和快速自旋回波（ＦＳＥ）序列对４９５例临床诊断为ＳＮＨＬ的患者进行磁共振检查。结果ＭＲＩ发现颅内病变２１１例（４２．６％），其中９５例（１９．２％）的ＳＮＨＬ病因为听觉传导通路上的病变。１１例内耳区病变为感觉性耳聋，另外８４例听神经或脑内听觉传导纤维受损为神经性耳聋。８４例中６２例病变位于内听道和桥小脑角区，脑内病变为２２例。结论ＳＮＨＬ病人ＭＲＩ检查应包括从耳蜗到颞横回的全部听觉传导通路。肿瘤、梗死软化、多发硬化、炎症、纡曲血管和囊肿都可引起ＳＮＨＬ。     

Hyperbaric oxygen therapy for idiopathic sudden sensorineural hearing loss

Idiopathic sudden sensorineural hearing loss (ISSHL) is the newest indication approved by the Undersea and Hyperbaric Medical Society's Hyperbaric Oxygen Therapy Committee. Idiopathic sudden sensorineural hearing loss appears to be characterized by hypoxia in the perilymph and therefore the scala tympani and the organ of Corti. A review of the literature reveals more than 100 publications evaluating the use of hyperbaric oxygen (HBO2) for the treatment of ISSHL, including eight randomized controlled trials. The best and most consistent results are obtained when HBO2 is initiated within two weeks of symptom onset and combined with corticosteroid treatment. The average hearing gain is 19.3 dB for moderate hearing loss and 37.7 dB for severe cases. This improvement brings hearing deficits from the moderate/severe range into the slight/no impairment range. This is a significant gain that can markedly improve a patient's quality of life, both clinically and functionally.     

A case of sudden unilateral sensorineural hearing loss with contralateral psychogenic hearing loss induced by gunshot noise

The reasons behind sudden sensorineural hearing loss are mostly unknown, but viral infections, blood disorders, ototoxicity, noise trauma, autoimmune disease, acoustic tumor, and even mental stress may be related to the disease. In cases of hearing loss as a result of psychogenic factors, early diagnosis and adequate treatment under collaboration with the psychiatric department are crucial, since failure to take appropriate measures may result in permanent sequela. We report a case, with a review of the literature, of sudden unilateral sensorineural hearing loss with contralateral psychogenic hearing loss induced by gunshot noise.     

Gait performance of children and adolescents with sensorineural hearing loss

BackgroundSeveral studies have demonstrated that children with sensorineural hearing loss (SNHL) may exhibit balance disorders, which can compromise the gait performance of this population.ObjectiveCompare the gait performance of normal hearing (NH) children and those with SNHL, considering the sex and age range of the sample, and analyze gait performance according to degrees of hearing loss and etiological factors in the latter group.MethodThis is a cross-sectional study that assessed 96 students, 48 NH and 48 with SNHL, aged between 7 and 18 years. The Brazilian version of the Dynamic Gait Index (DGI) was used to analyze gait and the Mann-Whitney test for statistical analysis.ResultsThe group with SNHL obtained lower average gait performance compared to NH subjects (p = 0.000). This was also observed when the children were grouped by sex female and male (p = 0.000). The same difference occurred when the children were stratified by age group: 7–18 years (p = 0.000). The group with severe and profound hearing loss exhibited worse gait performance than those with mild and moderate loss (p = 0.048) and children with prematurity as an etiological factor demonstrated the worst gait performance.ConclusionThe children with SNHL showed worse gait performance compared to NH of the same sex and age group. Those with severe and profound hearing loss and prematurity as an etiological factor demonstrated the worst gait performances.     

Bilateral petrous internal carotid artery pseudoaneurysms presenting with sensorineural hearing loss

We present a case of an 85-year-old woman with a 40-year history of progressive bilateral sensorineural hearing loss. Imaging studies demonstrated bilateral pseudoaneurysms of the petrous portion of the internal carotid arteries eroding into both cochleas. To our knowledge, this is the first case report of such lesions.     

DTI 评价双侧感音神经性耳聋患儿听觉通路的价值

目的：利用 MR 扩散张量成像(DTI)研究不同程度双侧感音神经性耳聋(BSNHL)患儿与正常婴幼儿听觉传导通路的差异;观察正常婴幼儿的听觉传导通路随年龄的变化。方法本院耳鼻喉门诊及住院部就诊的21例 BSNHL 患儿及24例正常婴幼儿,行 DTI 及内耳水成像扫描。用西门子后处理站测量下丘及内侧膝状体部位的各向异性分数(FA)值。根据纯音听力测试听阈值将实验组划分为甲、乙、丙3组,分别为轻度、中度、重度(本研究中包括极重度)感音神经性耳聋。轻度感音神经性耳聋的听阈为26~40 dB,中度为41~60 dB,重度为≥61 dB。结果甲组与对照组间 FA 值的差异无统计学意义(P >0.05);乙组、丙组与对照组下丘、内侧膝状体间 FA 值差异有统计学意义(P <0.05),且均小于对照组;对照组的 FA 值在2个感兴趣区(ROI)都随年龄的增长而增大。结论中度、重度 BSNHL 患儿下丘、内侧膝状体的 FA 值下降;FA 值在正常婴幼儿及轻度 BSNHL 的鉴别中价值有限。     

Pediatric sensorineural hearing loss, part 2: syndromic and acquired causes

This article is the second in a 2-part series reviewing neuroimaging in childhood SNHL. Previously, we discussed the clinical work-up of children with hearing impairment, the classification of inner ear malformations, and congenital nonsyndromic causes of hearing loss. Here, we review and illustrate the most common syndromic hereditary and acquired causes of childhood SNHL, with an emphasis on entities that demonstrate inner ear abnormalities on cross-sectional imaging. Syndromes discussed include BOR syndrome, CHARGE syndrome, Pendred syndrome, Waardenburg syndrome, and X-linked hearing loss with stapes gusher. We conclude the article with a review of acquired causes of childhood SNHL, including infections, trauma, and neoplasms.     

Pediatric sensorineural hearing loss, part 1: Practical aspects for neuroradiologists

SNHL is a major cause of childhood disability worldwide, affecting 6 in 1000 children. For children with prelingual hearing loss, early diagnosis and treatment is critical to optimizing speech and language development, academic achievement, and social and emotional development. Cross-sectional imaging has come to play an important role in the evaluation of children with SNHL because otolaryngologists routinely order either CT or MR imaging to assess the anatomy of the inner ears, to identify causes of hearing loss, and to provide prognostic information related to potential treatments. In this article, which is the first in a 2-part series, we describe the basic clinical approach to imaging of children with SNHL, including the utility of CT and MR imaging of the temporal bones; we review the most recent proposed classification of inner ear malformations; and we discuss nonsyndromic congenital causes of childhood SNHL.     

Congenital malformations of the inner ear and the vestibulocochlear nerve in children with sensorineural hearing loss: evaluation with CT and MRI

PURPOSE: The purpose of this work was to study the diagnostic value of CT and MRI in children with sensorineural hearing loss and to analyze anatomic abnormalities of the inner ear and the vestibulocochlear nerve in this patient group. METHOD: We evaluated 42 inner ears in 21 children with congenital deafness who had congenital inner ear malformations and who were candidates for cochlear implants. All patients were studied with high resolution MR and helical CT examinations. The MR study included a T2-weighted 3D fast SE sequence. We describe and tabulate the anatomic abnormalities. Special attention was given to abnormalities of the vestibulocochlear nerve. The field of view in the plane according to the length axis of the internal auditory canal (IAC) was 4 cm. Additional continuous parasagittal reformations perpendicular to the length axis of the IAC were studied with a field of view of 3 cm. RESULTS: CT and MRI allowed accurate identification of malformations of the inner ear in children with congenital deafness. We identified 99 malformations, with a majority of patients demonstrating multiple abnormalities. Common imaging findings were Mondini abnormality and Mondini variants (12/42) and fusion of the lateral or superior semicircular canal with the vestibule (12/42). MRI demonstrated in 9 of 21 patients a rudimentary or absent vestibulocochlear nerve in the auditory canal. CONCLUSION: CT and MRI are important modalities to analyze the inner ear in children who are candidates for cochlear implants. MRI with an extremely small field of view should be used to study possible abnormalities of the vestibulocochlear nerves. This may alter clinical care and allow cochlear implant placement in patients whose electrodiagnostic studies suggest that the implant should not be performed. The detailed analysis of abnormalities of the inner ear might establish prognostic factors.     

鼻咽癌放射治疗后感音神经性耳聋的临床分析

目的观察鼻咽癌患者放射治疗后感音神经性耳聋的发生率及探讨影响其发生的因素。方法对放射治疗后随访期满1年以上的25例鼻咽癌患者分别进行纯音听阈和声阻抗一导纳测试，并且收集相关的临床资料予以回顾性分析。结果所有患者随访期为12—94月(中位53月)。低频段和高频段感音神经性耳聋的发生率分别为8％和42％。对影响高频段感音神经性耳聋的单因素分析后发现，患者确诊时的年龄和随访时间有统计学意义(t=2．051，P=0．0458；t=2．978，P=0．0045)；而性别、确诊时是否主诉有听力下降和(或)耳鸣、鼻咽部照射剂量和是否联合应用含顺铂的化疗则均无统计学意义。采用Binary Logistic回归法多因素分析显示，患者确诊时的年龄和随访时间有统计学意义(P=0．02；P=0．009)。结论鼻咽癌放射治疗后高频段感音神经性耳聋的发生率明显高于低频段，影响高频段感音神经性耳聋发生的主要因素是患者确诊时的年龄和随访时间，而治疗前的听力水平、放疗剂量与是否联合应用含顺铂的化疗对其发生率的影响尚不明确。     

高压氧综合治疗突发性聋的疗效

目的：探讨高压氧（ＨＢＯ）联合药物治疗突发性聋（突聋）的疗效。方法：１７５例（１９３耳）突聋（ＨＢＯ组）在０．２５ＭＰａ（２．５ＡＴＡ）压力下吸纯氧３０分钟２次，中；司吸舱内空气１０分钟，每日１次；同时配合能量合剂、复方丹参液、低分子右旋糖酐、Ｂ族维生素、皮质激素等药物治疗，平均疗程１７．６±８．７天。将本组疗效与单纯使用同类药物治疗的９５例（１０２耳）突聋（非ＨＢＯ组）进行比较。结果：对不同病程、８ｋＨｚ听阈（≤９０ｄＢ及＞９０ｄＢ）、伴有眩晕或不伴有眩晕症状以及纯音听阈均值（ＰＴＡ）≤５５ｄＢ和＞５５ｄＢ的疗效，ＨＢＯ组均显著优于非ＨＢＯ组（Ｐ＜０．０５或Ｐ＜０．０１），而且疗程较短、耳鸣及眩晕症状缓解较快。结论：ＨＢＯ联合药物治疗突聋的效果明显优于单纯药物治疗。     

MRI findings of vestibulocochlear hemorrhage in a leukemic patient with sensorineural hearing loss

This case report presents a patient with M4 leukemia with signs and symptoms of acute sensorineural hearing loss. The patient's MRI demonstrated high signal on unenhanced T1-weighted images within the left vestibulocochlear complex that was consistent with subacute hemorrhage. Follow-up MRI showed clearing of the previously seen high T1-weighted signal from the left vestibulocochlear complex. This case report documents for the first time the MRI findings of vestibulocochlear complex hemorrhage in a leukemic patient.     

3T MRI容积再现技术在诊断感音神经性耳聋中的价值

感音神经性耳聋(sensorineural hearing loss,SNHL)为临床常见病,病变部位包括内耳、内听道和桥小脑角以及大脑内几个部分.新生儿先天性SNHL中约26%存在细微或严重内耳畸形,其中20%为骨迷路畸形,80%为膜迷路畸形[1].内耳膜迷路因其位置深在、结构精细复杂、体积微小且埋藏于颞骨岩部深处,因此一直是影像检查的难点[2].     

鼓室内注射地塞米松治疗中重度-重度突发性感音神经性聋

目的:观察鼓室内注射地塞米松对单侧中重度-重度突发性感音神经性聋的疗效.方法:选择经过常规治疗无效的单侧中重度-重度突发性感音神经性聋患者17耳,地塞米松经鼓膜穿刺鼓室内注射,2.5 mg/次,1次/3 d,10 d为1个疗程,共3次,比较治疗前后纯音听阈的变化情况.结果:治疗后纯音测听结果显示,1例显效,4例有效,12例无效,有效率为29.4%.结论:鼓室内注射地塞米松治疗可以改善部分常规治疗效果欠佳的中重度-重度突聋患者的听力.     

感音神经性耳聋者人工耳蜗术前的MRI研究进展

对于患感音神经性耳聋欲行人工耳蜗植入术的候选者,必须在术前排除该手术的各种禁忌证,因此,随着人工耳蜗植入手术的开展,MRI在术前检查中的地位愈加重要.就MRI对感音神经性聋的病人听觉系统结构及功能成像的技术和应用进展予以综述.     

HRCT测量耳蜗径线在诊断感音神经性耳聋中的价值

目的探讨高分辨CT(HRCT)测量耳蜗径线在诊断感音神经性耳聋(SNHL)中的应用价值。方法纳入经临床确诊、内耳结构大致正常的58例(116耳)SNHL患儿(SNHL组)颞骨HRCT影像,并与129例(258耳)无内耳异常的婴幼儿(正常组)颞骨HRCT影像进行对照,2组年龄均为0~36个月。观察SNHL患儿的影像表现,同时分别测量2组的耳蜗顶中周高度、底周长径及底周管内径,采用t检验对2组耳蜗径线进行比较。结果颞骨CT大致正常的部分SNHL患儿实际存在耳蜗结构异常。正常组的顶中周高度、底周长径和底周管内径均高于SNHL组[分别为(2.42±0.23)mm∶(2.71±0.19)mm、(7.75±0.52)mm∶(8.36±0.38)mm、(1.16±0.15)mm∶(1.33±0.09)mm,均P0.001]。结论对于颞骨HRCT大致正常的SNHL患儿,耳蜗径线测量有助于发现其存在的结构异常,在诊断SNHL中具有较高的应用价值。     

感音神经性耳聋者人工耳蜗术前的MRI研究进展

对于患感音神经性耳聋欲行人工耳蜗植入术的候选者,必须在术前排除该手术的各种禁忌证,因此,随着人工耳蜗植人手术的开展,MRI在术前检查中的地位愈加重要。就MRI对感音神经性聋的病人听觉系统结构及功能成像的技术和应用进展予以综述。     

高压氧治疗突发性耳聋的疗效及疗程选择

目的:探讨高压氧联合药物治疗对突发性耳聋的疗效判定及疗程的选择。方法:选取中国科学技术大学第一附属医院耳鼻咽喉科2017年1月至2018年12月收治的突发性耳聋患者95例。依据患者意愿分为对照组(单纯药物治疗,33例)、高压氧5次组(药物联合高压氧5次治疗,32例)和高压氧10次组(药物联合高压氧10次治疗,30例)。治疗前后比较纯音听力变化,观察3组患者不同治疗方案疗效的差异。结果:对照组总有效率54%,高压氧5次组总有效率56%,高压氧10次组总有效率83%。高压氧10次组疗效明显优于对照组和高压氧5次组,差异有统计学意义( P<0.05),对照组和高压氧5次组之间总有效率差异无统计学意义( P>0.05)。 结论:高压氧联合药物治疗有利于突聋患者听力恢复,但治疗疗程需满足1个疗程即10次治疗。